tbuckley/cabot-search huggingface dataset:
Randomized Clinical Trials of Machine Learning Interventions in Health Care
Authors: Deborah Plana, Dennis L. Shung, Alyssa A. Grimshaw, Anurag Saraf, Joseph J. Y. Sung, Benjamin H. Kann
Journal: JAMA Network Open (2022)

Importance Despite the potential of machine learning to improve multiple aspects of patient care, barriers to clinical adoption remain. Randomized clinical trials (RCTs) are often a prerequisite to large-scale clinical adoption of an intervention, and important questions remain regarding how machine learning interventions are being incorporated into clinical trials in health care. Objective To systematically examine the design, reporting standards, risk of bias, and inclusivity of RCTs for medical machine learning interventions. Evidence Review In this systematic review, the Cochrane Library, Google Scholar, Ovid Embase, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection online databases were searched and citation chasing was done to find relevant articles published from the inception of each database to October 15, 2021. Search terms for machine learning, clinical decision-making, and RCTs were used. Exclusion criteria included implementation of a non-RCT design, absence of original data, and evaluation of nonclinical interventions. Data were extracted from published articles. Trial characteristics, including primary intervention, demographics, adherence to the CONSORT-AI reporting guideline, and Cochrane risk of bias were analyzed. Findings Literature search yielded 19 737 articles, of which 41 RCTs involved a median of 294 participants (range, 17-2488 participants). A total of 16 RCTS (39%) were published in 2021, 21 (51%) were conducted at single sites, and 15 (37%) involved endoscopy. No trials adhered to all CONSORT-AI standards. Common reasons for nonadherence were not assessing poor-quality or unavailable input data (38 trials [93%]), not analyzing performance errors (38 [93%]), and not including a statement regarding code or algorithm availability (37 [90%]). Overall risk of bias was high in 7 trials (17%). Of 11 trials (27%) that reported race and ethnicity data, the median proportion of participants from underrepresented minority groups was 21% (range, 0%-51%). Conclusions and Relevance This systematic review found that despite the large number of medical machine learning–based algorithms in development, few RCTs for these technologies have been conducted. Among published RCTs, there was high variability in adherence to reporting standards and risk of bias and a lack of participants from underrepresented minority groups. These findings merit attention and should be considered in future RCT design and reporting.
Prescribing Characteristics Associated With Opioid Overdose Following Buprenorphine Taper
Authors: Nikki Bozinoff, Siyu Men, Paul Kurdyak, Peter Selby, Tara Gomes
Journal: JAMA Network Open (2022)

Importance Retention in buprenorphine therapy is associated with a lower risk of opioid overdose. Nevertheless, many patients discontinue treatment, and there is limited evidence to guide buprenorphine tapering. Objective To understand what prescribing characteristics are associated with opioid overdose following buprenorphine taper. Design, Setting, and Participants This is a population-based, retrospective, cohort study of adults who were maintained on buprenorphine for at least 60 days and underwent a buprenorphine taper. The study was conducted in the Canadian province of Ontario, using linked administrative health data. New buprenorphine treatment episodes were accrued between January 1, 2013, and January 1, 2019, and the maximum follow-up was April 30, 2020. Data analysis was performed from December 2020 to August 2022. Exposures The primary exposure of interest was time to taper initiation (≤1 year vs &amp;amp;gt;1 year). Secondary exposures included mean rate of taper, percentage days during which the dose was decreasing, and taper duration. Main Outcomes and Measures The primary outcome measure was time to fatal or nonfatal opioid overdose within 18 months following treatment discontinuation. Results Among 5774 individuals, the median (IQR) age at index date was 34 (28-44) years, and 3462 individuals (60.0%) were male. Time to taper initiation longer than 1 year vs 1 year or less (6.73 vs 10.35 overdoses per 100 person-years; adjusted hazard ratio [aHR], 0.69; 95% CI, 0.48-0.997), a lower mean rate of taper (≤2 mg per month, 6.95 overdoses per 100 person-years; &amp;amp;gt;2 to ≤4 mg per month, 11.48 overdoses per 100 person-years; &amp;amp;gt;4 mg per month, 17.27 overdoses per 100 person-years; ≤2 mg per month vs &amp;amp;gt;4 mg per month, aHR, 0.65; 95% CI, 0.46-0.91; &amp;amp;gt;2 to ≤4 mg per month vs &amp;amp;gt;4 mg per month, aHR, 0.69; 95% CI, 0.51-0.93), and dose decreases in 1.75% or less of days vs more than 3.50% of days during the taper period (5.87 vs 13.87 overdoses per 100 person-years; aHR, 0.64; 95% CI, 0.43-0.93) were associated with reduced risk of opioid overdose; however, taper duration was not. Conclusions and Relevance In this retrospective cohort study, buprenorphine tapers undertaken after at least 1 year of therapy, a slower rate of taper, and a lower percentage of days during which the dose was decreasing were associated with a significantly lower risk of opioid overdose, regardless of taper duration. These findings underscore the importance of a carefully planned taper and could contribute to reduction in opioid-related overdose death.
Cholera Vaccine: Recommendations of the Advisory Committee on Immunization Practices, 2022
Authors: Jennifer P. Collins, Edward T. Ryan, Karen K. Wong, Matthew F. Daley, Adam J. Ratner, Grace D. Appiah, Pablo J. Sanchez, Bruce J. Gutelius
Journal: MMWR Recommendations and Reports (2022)

THIS REPORT SUMMARIZES ALL RECOMMENDATIONS FROM CDC'S ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) FOR THE USE OF LYOPHILIZED CVD 103-HGR VACCINE (CVD 103-HGR) (VAXCHORA, EMERGENT BIOSOLUTIONS, GAITHERSBURG, MD) IN THE UNITED STATES. THE LIVE ATTENUATED ORAL CHOLERA VACCINE IS DERIVED FROM: Vibrio cholerae O1 and is administered in a single dose. Cholera is a toxin-mediated bacterial gastrointestinal illness caused by toxigenic V. cholerae serogroup O1 or, uncommonly, O139. Up to 10% of infections manifest as severe cholera (i.e., cholera gravis), profuse watery diarrhea that can cause severe dehydration and death within hours. Fluid replacement therapy can reduce the fatality rate to <1%. Risk factors for cholera gravis include high dose exposure, blood group O, increased gastric pH (e.g., from antacid therapy), and partial gastrectomy. Cholera is rare in the United States, but cases occur among travelers to countries where cholera is endemic or epidemic and associated with unsafe water and inadequate sanitation. Travelers might be at increased risk for poor outcomes from cholera if they cannot readily access medical services or if they have a medical condition that would be worsened by dehydration, such as cardiovascular or kidney disease. This report describes previously published ACIP recommendations about use of CVD 103-HgR for adults aged 18-64 years and introduces a new recommendation for use in children and adolescents aged 2-17 years. ACIP recommends CVD 103-HgR, the only cholera vaccine licensed for use in the United States, for prevention of cholera among travelers aged 2-64 years to an area with active cholera transmission. Health care providers can use these guidelines to develop the pretravel consultation for persons traveling to areas with active cholera transmission.
Effectiveness of a Second COVID-19 Vaccine Booster Dose Against Infection, Hospitalization, or Death Among Nursing Home Residents — 19 States, March 29–July 25, 2022
Authors: Kevin W. McConeghy, Elizabeth M. White, Carolyn Blackman, Christopher M. Santostefano, Yoojin Lee, James L. Rudolph, David Canaday, Andrew R. Zullo, John A. Jernigan, Tamara Pilishvili, Vincent Mor, Stefan Gravenstein
Journal: MMWR Morbidity and Mortality Weekly Report (2022)

Nursing home residents continue to experience significant COVID-19 morbidity and mortality (1). On March 29, 2022, the Advisory Committee on Immunization Practices (ACIP) recommended a second mRNA COVID-19 vaccine booster dose for adults aged ≥50 years and all immunocompromised persons who had received a first booster ≥4 months earlier.* On September 1, 2022, ACIP voted to recommend bivalent mRNA COVID-19 vaccine boosters for all persons aged ≥12 years who had completed the primary series using monovalent vaccines ≥2 months earlier (2). Data on COVID-19 booster dose vaccine effectiveness (VE) in the nursing home population are limited (3). For this analysis, academic, federal, and private partners evaluated routine care data collected from 196 U.S. community nursing homes to estimate VE of a second mRNA COVID-19 vaccine booster dose among nursing home residents who had received 3 previous COVID-19 vaccine doses (2 primary series doses and 1 booster dose). Residents who received second mRNA COVID-19 vaccine booster doses during March 29-June 15, 2022, with follow-up through July 25, 2022, were found to have 60-day VE of 25.8% against SARS-CoV-2 (the virus that causes COVID-19 infection), 73.9% against severe COVID-19 outcomes (a combined endpoint of COVID-19-associated hospitalizations or deaths), and 89.6% against COVID-19-associated deaths alone. During this period, subvariants BA.2 and BA.2.12.1 (March-June 2022), and BA.4 and BA.5 (July 2022) of the B.1.1.529 and BA.2 (Omicron) variant were predominant. These findings suggest that among nursing home residents, second mRNA COVID-19 vaccine booster doses provided additional protection over first booster doses against severe COVID-19 outcomes during a time of emerging Omicron variants. Facilities should continue to ensure that nursing home residents remain up to date with COVID-19 vaccination, including bivalent vaccine booster doses, to prevent severe COVID-19 outcomes.
<i>Notes from the Field</i>: Overdose Deaths Involving <i>Para</i>-fluorofentanyl — United States, July 2020–June 2021
Authors: Jessica Bitting, Julie O’Donnell, Christine L. Mattson
Journal: MMWR Morbidity and Mortality Weekly Report (2022)

Provisional estimates indicate that synthetic opioids, including illicitly manufactured fentanyl (IMF), were involved in approximately two thirds of an estimated 108,174 overdose deaths in the United States during the 12 months ending in April 2022.*Previous analyses have identified para-fluorofentanyl, a schedule I † illicit fentanyl analog, in drug overdose deaths in eight states from late 2020 through June 2021 (1-3).Limited data suggest that para-fluorofentanyl is likely similar to or slightly less potent than IMF (3,4); however, its role in the illicit drug market and its impact on the opioid overdose crisis has not been widely studied.To better understand monthly trends in drug overdose deaths involving para-fluorofentanyl in the United States, CDC analyzed overdose death data from the State Unintentional Drug Overdose Reporting System (SUDORS).SUDORS includes data from death certificates and medical examiner and coroner reports (including enhanced postmortem toxicology testing) on unintentional and undetermined-intent drug overdose deaths.CDC assessed monthly frequencies of overdose deaths during July 2020-June 2021 involving (i.e., listed as a cause of death) para-fluorofentanyl, among 42 states § and the District of Columbia.Para-fluorofentanyl-involved deaths were stratified by jurisdiction and U.S. Census Bureau region.
Implementation of covid-19 vaccination in the United Kingdom
Authors: Azeem Majeed, Katrina Pollock, Simon Hodes, Marisa Papaluca
Journal: BMJ (2022)

Decisions about approving covid-19 vaccines and strategies for their use in the UK must be rapid and transparent, say <b>Azeem Majeed and colleagues</b>, and a sustainable infrastructure should be put in place for delivering covid-19 vaccines to the public
Simplifying Infusion Chemotherapy: Preliminary Communication
Authors: S R Ebbs, J A Saunders, J V Roberts, M Baum, T Bates, J E Morris
Journal: Journal of the Royal Society of Medicine (1988)

A low-intervention policy for Hickman catheter maintenance has been evaluated and found to be safe and cost effective. A simple, lightweight, disposable device has been used for 24–hour ambulatory home infusion. Implementation of this policy as part of a prospective randomized trial of single-agent chemotherapy in advanced breast cancer has demonstrated that slow intravenous infusion reduces the acute toxicity of epirubicin when compared with bolus injection.
Ann Robinson’s research reviews—29 September 2022
Authors: Ann Robinson
Journal: BMJ (2022)

Hope for psoriasis treatmentsPsoriasis is a serious global condition, and according to the WHO, has no clear cause or cure.That's not much comfort to the 100 million people worldwide who live with its unpredictable course and possible skin, joint, metabolic, bowel, and psychological manifestations.New treatments are sorely needed, and there's optimism about PDE-4 inhibitors-a class of drugs that inhibit the enzyme phosphodiesterase (PDE) involved in inflammation.PDE-4 inhibitor roflumilast has undergone two phase 3 trials of 881 patients aged 2 years and over with chronic plaque psoriasis affecting 2-20% of their body area.Once daily topical roflumilast 0.3% cream achieved statistically better results than inactive vehicle cream (42.4% v 6.1% in one trial and 37.5% v 6.9% in the other).Success was primarily judged using an Investigator Global Assessment to measure whether plaques had cleared or almost cleared by eight weeks.Results also looked good for difficult-to-treat areas such as skin creases under the arms and breasts.Side effects after treatment were similar for active and inactive creams in both trials (around 25%), and there were few or no serious adverse effects in all groups (0-0.7%).
African-specific alleles modify risk for asthma at the 17q12-q21 locus in African Americans
Authors: Charles Washington, Matthew Dapas, Arjun Biddanda, Kevin M. Magnaye, Ivy Aneas, Britney A. Helling, Brooke Szczesny, Meher Preethi Boorgula, Margaret A. Taub, Eimear Kenny, Rasika A. Mathias, Kathleen C. Barnes, Monica Campbell, Camila Figueiredo, Nadia N. Hansel, Carole Ober, Christopher O. Olopade, Charles N. Rotimi, Harold Watson, Gurjit K. Khurana Hershey, Carolyn M. Kercsmar, Jessica D. Gereige, Melanie Makhija, Rebecca S. Gruchalla, Michelle A. Gill, Andrew H. Liu, Deepa Rastogi, William Busse, Peter J. Gergen, Cynthia M. Visness, Diane R. Gold, Tina Hartert, Christine C. Johnson, Robert F. Lemanske, Fernando D. Martinez, Rachel L. Miller, Dennis Ownby, Christine M. Seroogy, Anne L. Wright, Edward M. Zoratti, Leonard B. Bacharier, Meyer Kattan, George T. O’Connor, Robert A. Wood, Marcelo A. Nobrega, Matthew C. Altman, Daniel J. Jackson, James E. Gern, Christopher G. McKennan, Carole Ober
Journal: Genome Medicine (2022)

Asthma is the most common chronic disease in children, occurring at higher frequencies and with more severe disease in children with African ancestry. We tested for association with haplotypes at the most replicated and significant childhood-onset asthma locus at 17q12-q21 and asthma in European American and African American children. Following this, we used whole-genome sequencing data from 1060 African American and 100 European American individuals to identify novel variants on a high-risk African American-specific haplotype. We characterized these variants in silico using gene expression and ATAC-seq data from airway epithelial cells, functional annotations from ENCODE, and promoter capture (pc)Hi-C maps in airway epithelial cells. Candidate causal variants were then assessed for correlation with asthma-associated phenotypes in African American children and adults. Our studies revealed nine novel African-specific common variants, enriched on a high-risk asthma haplotype, which regulated the expression of GSDMA in airway epithelial cells and were associated with features of severe asthma. Using ENCODE annotations, ATAC-seq, and pcHi-C, we narrowed the associations to two candidate causal variants that are associated with features of T2 low severe asthma. Previously unknown genetic variation at the 17q12-21 childhood-onset asthma locus contributes to asthma severity in individuals with African ancestries. We suggest that many other population-specific variants that have not been discovered in GWAS contribute to the genetic risk for asthma and other common diseases.
Holiday Drinking and Highway Fatalities
Authors: Julian A. Waller
Journal: JAMA (1968)

Blood alcohol concentrations, condition of liver, and arrests were studied for 1251 consecutive highway deaths of persons aged 15 years or older who survived less than six hours after crashes in three California counties. Fifty-eight percent of the drivers, 47% of the passengers, and 36% of the pedestrians had alcohol in their blood, usually concentrations of 150 mg/100 ml or higher. About two thirds of such high concentrations were associated with fatty livers or previous arrests, usually involving alcohol,
The transverse nasal line: an embryonic fault line
Authors: W.B. SHELLEY, E.D. SHELLEY, B. PANSKY
Journal: British Journal of Dermatology (1997)

The transverse nasal line has long been neglected and frequently overlooked. This narrow pink or hyperpigmented line or groove extends transversely between the upper two-thirds and the lower third of the nose. It is often hereditary and may be the locus of comedones and milia. Eighteen examples are reported by us, along with a possible embryological interpretation.
<i>QuickStats</i>: Percentage of Residential Care Communities* that Use Electronic Health Records,† by Community Bed Size — United States, 2016 and 2020§
Authors: Christine Caffrey, Manisha Sengupta
Journal: MMWR Morbidity and Mortality Weekly Report (2022)

All residential care communities 4-10 11-25 26-50 51-100 >100 PercentageCommunity bed size 100 * Residential care communities are state-regulated, have four or more beds, provide room and board with at least two meals a day, and are staffed around the clock to provide supervision and assistance with personal care and health-related services to adults.Residential care communities licensed to exclusively serve persons who are mentally ill, intellectually disabled, or developmentally disabled were excluded.† Respondents were asked, "An Electronic Health Record is a computerized version of the resident's health and personal information used in the management of the resident's health care.Other than for accounting or billing purposes, does this residential care community use Electronic Health Records?" § Residential care communities with missing data were excluded.From 2016 to 2020, the percentage of residential care communities using electronic health records increased from 26% to 41%.The percentage using electronic health records increased from 28% to 41% for 11-25 bed communities, 35% to 54% for 26-50 bed communities, 43% to 71% for 51-100 bed communities, and 50% to 74% for more than 100 bed communities.The change (from 12% to 14%) was not significant for 4-10 bed communities.
Harnessing the Vnn1 pantetheinase pathway boosts short chain fatty acids production and mucosal protection in colitis
Authors: Virginie Millet, Thomas Gensollen, Michael Maltese, Melanie Serrero, Nathalie Lesavre, Christophe Bourges, Christophe Pitaval, Sophie Cadra, Lionel Chasson, Thien Phong Vu Man, Marion Masse, Juan Jose Martinez-Garcia, Fabrice Tranchida, Laetitia Shintu, Konrad Mostert, Erick Strauss, Patricia Lepage, Mathias Chamaillard, Achille Broggi, Laurent Peyrin-Biroulet, Jean-Charles Grimaud, Philippe Naquet, Franck Galland
Journal: Gut (2022)

Objective In the management of patients with IBD, there is a need to identify prognostic markers and druggable biological pathways to improve mucosal repair and probe the efficacy of tumour necrosis factor alpha biologics. Vnn1 is a pantetheinase that degrades pantetheine to pantothenate (vitamin B 5 , a precursor of coenzyme A (CoA) biosynthesis) and cysteamine. Vnn1 is overexpressed by inflamed colonocytes. We investigated its contribution to the tolerance of the intestinal mucosa to colitis-induced injury. Design We performed an RNA sequencing study on colon biopsy samples from patients with IBD stratified according to clinical severity and modalities of treatment. We generated the VIVA mouse transgenic model, which specifically overexpresses Vnn1 on intestinal epithelial cells and explored its susceptibility to colitis. We developed a pharmacological mimicry of Vnn1 overexpression by administration of Vnn1 derivatives. Results VNN1 overexpression on colonocytes correlates with IBD severity. VIVA mice are resistant to experimentally induced colitis. The pantetheinase activity of Vnn1 is cytoprotective in colon: it enhances CoA regeneration and metabolic adaptation of colonocytes; it favours microbiota-dependent production of short chain fatty acids and mostly butyrate, shown to regulate mucosal energetics and to be reduced in patients with IBD. This prohealing phenotype is recapitulated by treating control mice with the substrate (pantethine) or the products of pantetheinase activity prior to induction of colitis. In severe IBD, the protection conferred by the high induction of VNN1 might be compromised because its enzymatic activity may be limited by lack of available substrates. In addition, we identify the elevation of indoxyl sulfate in urine as a biomarker of Vnn1 overexpression, also detected in patients with IBD. Conclusion The induction of Vnn1/VNN1 during colitis in mouse and human is a compensatory mechanism to reinforce the mucosal barrier. Therefore, enhancement of vitamin B 5 -driven metabolism should improve mucosal healing and might increase the efficacy of anti-inflammatory therapy.
Implementing the National Heart, Lung, and Blood Institute’s Strategic Vision in the Division of Cardiovascular Sciences—2022 Update
Authors: Meagan G. Grant, Charlotte Pratt, Renee P. Wong, Ebyan Addou, Patrice Desvigne-Nickens, Rebecca A. Campo, Laurie Friedman Donze, Vanessa I. Barnes, David W. Schopfer, Cashell E. Jaquish, Jerome Fleg, Zorina S. Galis, Kathleen Fenton, Young S. Oh, Yuling Hong, Jue Chen, Wayne Wang, Lawrence Fine, David C. Goff
Journal: Circulation Research (2022)

Spurred by the 2016 release of the National Heart, Lung, and Blood Institute's Strategic Vision, the Division of Cardiovascular Sciences developed its Strategic Vision Implementation Plan-a blueprint for reigniting the decline in cardiovascular disease (CVD) mortality rates, improving health equity, and accelerating translation of scientific discoveries into better cardiovascular health (CVH). The 6 scientific focus areas of the Strategic Vision Implementation Plan reflect the multifactorial nature of CVD and include (1) addressing social determinants of CVH and health inequities, (2) enhancing resilience, (3) promoting CVH and preventing CVD across the lifespan, (4) eliminating hypertension-related CVD, (5) reducing the burden of heart failure, and (6) preventing vascular dementia. This article presents an update of strategic vision implementation activities within Division of Cardiovascular Sciences. Overarching and cross-cutting themes include training the scientific workforce and engaging the extramural scientific community to stimulate transformative research in cardiovascular sciences. In partnership with other NIH Institutes, Federal agencies, industry, and the extramural research community, Division of Cardiovascular Sciences strategic vision implementation has stimulated development of numerous workshops and research funding opportunities. Strategic Vision Implementation Plan activities highlight innovative intervention modalities, interdisciplinary systems approaches to CVD reduction, a life course framework for CVH promotion and CVD prevention, and multi-pronged research strategies for combatting COVID-19. As new knowledge, technologies, and areas of scientific research emerge, Division of Cardiovascular Sciences will continue its thoughtful approach to strategic vision implementation, remaining poised to seize emerging opportunities and catalyze breakthroughs in cardiovascular sciences.